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Supreme Court Case Could Add Women's Health Hurdles in Texas

The U.S. Supreme Court on Tuesday is poised to hear two cases that could add additional hurdles for women seeking reproductive health coverage in Texas.

Those cases — which pit Hobby Lobby Stores and Conestoga Wood Specialties, a cabinetry manufacturer, against U.S. Health and Human Services Secretary Kathleen Sebelius — could exempt corporations from providing coverage of certain contraceptivesto their employees based on the owners' religious beliefs.

In Texas, advocates for reproductive health services are watching the debate closely, given the Republican-led Legislature's 2011 cuts to subsidized family planning services for poor women and the resulting closure of more than a dozen women's health clinics.

"Thousands of women lost access to birth control and life-saving cancer screenings and well-woman exams” as a result of those cuts, said Sarah Wheat, vice president for community affairs for Planned Parenthood of Greater Texas. The Supreme Court cases could “have a particularly harmful impact on women who work in hourly positions at corporations like Hobby Lobby and struggle to pay for their health care.”

But opponents of the federal Affordable Care Act's contraception mandate say it is wildly hypocritical. At issue in these cases are two types of intrauterine devices and emergency contraceptives including Plan B and ella.

“People are demanding that their boss stay out of their reproductive heath care choices, and that they pay for those choices,” said Stephen Casey, chief counsel for the Texas Center for Defense of Life, which filed a brief with the Supreme Court in support of Hobby Lobby and Conestoga Wood Specialties.

In Texas there are 89 Hobby Lobby stores, but this case could affect many more women than those employed at the chain of arts and crafts stores. According to the American Civil Liberties Union, there are 47 cases pending at different levels of jurisdiction where for-profit companies are challenging the federal Affordable Care Act’s contraceptive mandate, which requires employers to cover some of the contraceptive costs for their employees' heath insurance plans. In 2013, the U.S. Department of Health and Human Services granted an exception for churches and other places of worship, but there is no precedent for corporations claiming a religious objection on the issue.

"Standing up for religious beliefs is as much a part of Texas as is anything," said state Rep. Brandon Creighton, R-Conroe, who is in a special election to replace outgoing state Sen. Tommy Williams, R-The Woodlands.

Although none of those cases originated in Texas, a Supreme Court ruling in favor of Hobby Lobby and Conestoga Wood Specialties could have an outsize impact in a state where leaders are overwhelmingly Republican and opposed to the Affordable Care Act, and where no law exists that requires contraceptive coverage. Texas is not one of the 28 U.S. states that require employers who provide prescription drug coverage to their employees to also provide contraceptive coverage, according to the Guttmacher Institute, an advocacy and research organization that promotes abortion rights but produces data cited by both sides.

Lucy Nashed, a spokeswoman for Gov. Rick Perry, said the governor "believes Obamacare is a misguided and overreaching law that significantly limits personal choice," and that he is a "staunch believer in the religious freedoms protected by the U.S. Constitution, and the state of Texas is one of 20 states that filed an amicus brief in support of Hobby Lobby's position."

Advocates for contraceptive coverage of all kinds say that if the high court rules in the companies' favor, it would be yet another barrier for Texas women seeking reproductive care. “Whether an employee accesses birth control should be between a woman and her doctor — not up to her boss to decide,” Wheat said.

But Casey and his group believe that if the high court does not allow these exemptions, it will hurt Texas businesses and force company owners to operate against their conscience.

“Tons of companies will shut down to stay consistent with their conscience,” said Casey, whose group believes that some forms of contraception are representative of abortion. “You couldn’t have a hit man fund for your company. It’s the same type of thing.”

Cecile Richards, president of the Planned Parenthood Federation of America, said in a press conference last week that people who link contraception to abortion are "entitled to your own opinions but not to your own facts." And advocates for reproductive health care fear these cases could have a much broader scope than contraception. Brigitte Amiri, a senior staff attorney with the American Civil Liberties Union's reproductive freedom project, said that if the court issues a broad ruling in favor of the corporations — as opposed to narrow, specific exemptions for the two companies — it could open the door for other types of religious exemptions for certain types of heath care covered under the ACA, like vaccinations.

State Sen. Carlos Uresti, D-San Antonio, said that "no matter the outcome of the Hobby Lobby case,” he expects GOP lawmakers to introduce bills in the 2015 legislative session that deny services based on companies' objections.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.